Deaths from Opioid Misuse on the Rise
The CDC estimates that 115 people die each day from an overdose of opioids. In the last 15 years that translates to over ½ million people. This includes legal drugs prescribed to treat pain, and illegal drugs such as street heroin and the synthetic opioids. There has been a 72% increase in deaths from the synthetic fetanyls (a type of opioid) smuggled in from China and Mexico, way surpassing the deaths from legal prescriptions.
Physicians Can Play A Vital Role In Stemming Opioid Misuse
Physicians have taken a lot of heat from politicians blaming us for writing too many prescriptions and for too many pills that then get diverted; we all know it wasn’t long ago that we were blamed for not adequately treating pain as it became a fifth vital sign in hospitals. There is a middle ground and we do have a vital role to play in all our practices to be leaders in reversing this national epidemic.
MDs Taking A Lead in Stemming Opioid Misuse
I was convinced that doctors could take a lead to stem this epidemic starting in their own offices. Therefore, I personally convened a study in my practice, and added a few other doctor practices, and our results1 were just recently published in JAMA Facial Plastic Surgery.* By examining how many pills we routinely wrote for patients after a nasal surgery and comparing that to the average actually used and needed by our patients, we were able to prescribe many fewer pills than before and still keep the majority of our patients pain free. We now prescribe one half the number of pills we did before, so there is less chance for any diversion occurring in patients’ homes by friends or relatives or by selling unused meds on the street.
There are many other areas in which we as physicians can help. We can talk to patients about disposing of unused medications and about locking up controlled substance meds in their homes. We can go online with our state Prescription Drug Monitoring Programs (PDMP) and check to see if any of our patients are getting unneeded opioids from other physicians before we add another prescription to the mix. We can use non-opioid medications instead when pain is less severe or chronic. We can take additional training on safe opioid prescribing. We can lobby for payment for multi-disciplinary pain care and substance abuse. And the government needs to stop the smuggling of street opioids into this country.
Keeping the spotlight on other epidemics important too
Opioids have come to the forefront recently, but we as physicians also know there are many other epidemics that still need to be in the public and governmental spotlight. For instance, the still number one preventable cancer with most lives lost per year (eclipsing opioid deaths) is lung cancer, with tobacco and smoking as the culprits. An old subject, but still a major social problem and killer.
* The full text of “Opioid Use by Patients After Rhinoplasty;” Sagar, Patel, MD; Michael Bobian, MD; Peter F. Syider, MD; Giancarlo Zuiliano, MD; Russell Kridel, MD, can be found in JAMA Facial Plast Surg. 2018;20(1):24-30. doi:10.1001/jamafacial.2017.1034.
Houston Facial Plastic Surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees. Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.